Optimizing Glaucoma Care in Ghana: A Mixed-Methods Study of Optometrists' Practices, Challenges, and Capacity Needs

Youth experiencing early psychosis in West Africa often face delays in accessing evidence-based treatment. Digital mental health interventions may offer an acceptable and scalable approach to improve access to early psychosis care in West Africa; however, few data exist on the experiences and perspectives of patients with early psychosis and their caregivers to inform digital intervention development. This study aims to explore current experiences of early psychosis care, identify barriers and facilitators to in-person early psychosis care within health facilities, and identify opportunities for digital interventions to support patients with early psychosis and caregivers in Ghana. We conducted qualitative focus group discussions among patients with early psychosis, their caregivers, and their mental health care providers recruited at Accra Psychiatric Hospital in Accra, Ghana. Trained qualitative researchers facilitated discussions using a structured qualitative interview guide, exploring current care practices for early psychosis in Ghana, barriers and facilitators to facility-based care, and perceptions of digital mental health interventions. Transcripts were translated, transcribed, and analyzed thematically using a hybrid inductive and deductive approach grounded in the theoretical framework of acceptability. Overall, we conducted 4 focus group discussions (N=31) among 7 patients with early psychosis (median age 28, IQR 21-41 years), 6 caregivers (median age 58, IQR 29-34 years), and 18 clinicians (median age 30, IQR 29-34 years). Participants described current early psychosis care practices in Ghana, including seeking spiritual and traditional healing, the dearth of information and resources about psychosis, and the integral role of caregivers in facilitating treatment engagement and continuation (often at the cost of caregiver mental distress and burnout). Common barriers to facility-based mental health care included stigma associated with mental illness, lack of prior knowledge about early psychosis and treatment options, and practical constraints (eg, financial, logistical, and health care system limitations). Motivating factors for facility-based care included success stories from community members and strong rapport and trust in mental health clinicians. Technology (eg, mobile phones, laptops, radio, and television) was commonly used among participants in typical daily tasks, health information seeking, and stress reduction. Participants expressed support for digital tools that could deliver psychoeducation about early psychosis, support treatment adherence, and extend patient-provider communication between clinic visits. Digital mental health interventions have the potential to complement facility-based early psychosis services in Ghana by addressing misinformation, reducing access barriers, and supporting caregiver roles. These qualitative findings inform potential integration points, content, attributes, and strengths of digital modalities that could be leveraged to support patients with early psychosis and their caregivers in Ghana.

The first week of life presents the greatest risk of dying for a young infant. Yet, due to the sociocultural, financial, geographical and health system barriers found in many resource-poor settings, infants do not access health care until much later. To reduce neonatal mortality, the Ghana Health Service proposed a new policy that promotes skilled care during the first week of life. We report the results of an initiative that uses quality improvement (QI) methods to test the feasibility and effectiveness of the new early post-natal care (PNC) policy and its subsequent scale-up throughout northern Ghana. Over a 10-month period, 30 networked QI teams from 27 rural health facilities developed and tested both facility-based and community-based changes to their processes of maternal and neonatal care. Coverage and outcome data were analysed using an interrupted time-series design. Over 24 months, early PNC increased from a mean of 15% to 71% for visits within the first 48 h, and from 0% to 53% for visits on Day 6 or 7. We observed a slower increase in skilled delivery (mean of 56% to 82%) over a longer period of time (35 months). Facility-based neonatal mortality remained unchanged: mean of 5.1 deaths per 1000 deliveries. Using the most effective change ideas developed in the 27 test facilities, the early PNC policy was scaled up over the subsequent 2 years to 576 health facilities in all 38 districts of northern Ghana. This initiative demonstrates the utility of a QI approach in testing, implementing and subsequent scaling up a national policy for early PNC in a resource-constrained setting. This approach provides a model for improving the implementation of other national health policies to accelerate the achievement of the Millennium Development Goals in Ghana and other resource-poor countries.

Background: Cochlear implants (CIs) are the gold standard intervention for severe-to-profound sensorineural hearing loss. Their success depends not only on technological advancements but also on the knowledge, attitudes, and practices (KAP) of otolaryngologists responsible for patient selection, counselling, and postoperative management. Objective: This study aimed to evaluate the KAP of otolaryngologists in the UAE towards CIs, identify gaps in training and decision-making, and assess adherence to global CI protocols. Methods: A cross-sectional study was conducted using a self-administered online questionnaire distributed to otolaryngologists across public and private healthcare institutions in the UAE. The survey assessed demographics, clinical knowledge, attitudes towards CIs, and clinical practices. Descriptive and inferential statistical analyses were performed to assess the relationships among knowledge levels, referral frequency, and institutional factors. Results: A total of 31 otolaryngologists participated. While 74% demonstrated moderate-to-high knowledge of CIs, 39% had low awareness of national guidelines. Most (61%) strongly supported CI integration into treatment protocols, but financial and institutional barriers were frequently cited as challenges. Knowledge levels significantly correlated with referral frequency (p < 0.001), indicating a gap between awareness and practice. Conclusions: This is the first study in the UAE assessing otolaryngologists' KAP regarding CIs. Despite favourable attitudes, limited guideline awareness, financial barriers, and inconsistent multidisciplinary collaboration remain challenges. Targeted clinician education, standardised CI guidelines aligned with international benchmarks, and improved funding mechanisms are essential to enhance CI accessibility and optimise patient outcomes in the region.

ObjectivesThe efficacy of exercise-based cardiac rehabilitation (CR) for patient outcomes is well established, with better outcomes when delivery meets recommended guidelines. The aim of this study was to assess how...

Breast cancer is not just a disease; it is a global crisis that continues to claim lives, especially in low- and middle-income countries (LMICs), where late-stage diagnosis is the norm rather than the exception. Unlike high-income countries (HICs), where early detection has significantly improved survival rates, women in LMICs face an uphill battle against fragmented healthcare systems, limited diagnostic tools, cultural barriers, and financial constraints. The very technologies that revolutionized screening in HICs remain out of reach for many, leaving millions vulnerable to preventable deaths. This article calls for bold leadership and coordinated global efforts to ensure that every woman, regardless of geography or socio-economic status, has access to life-saving early detection and treatment, in addition to highlighting the urgent need for equitable breast cancer screening in LMICs and exploring innovative approaches that have the potential to transform early detection and improve outcomes. Decentralized diagnostic hubs, artificial intelligence (AI)-powered imaging, mobile screening units, and public-private partnerships are emerging as viable solutions to bridge the gap. Moreover, creative financing models and culturally tailored awareness campaigns offer hope for overcoming financial and social barriers. We can drive a paradigm shift towards equity in cancer care by reimagining breast cancer screening through technology and community engagement.

Patient Nonadherence and Treatment Response to Imatinib in Patients with Chronic Myeloid Leukemia: Results from the ADAGIO Study

ABSTRACTObjective: To determine the effect of blood flow restriction (BFR) applied to the legs at different pressures (40% and 60%) on intraocular pressure (IOP) during the execution of ten repetitions maximum (10RM) in the half-squat exercise. Methods: Quasi-experimental, prospective study with 17 healthy physically active subjects (9 males and 8 females; 24.1 ± 4.2 years). Two sessions were conducted. The 10RM load was determined in the first session. The second session consisted of 10RM under three BFR conditions (no-BFR, 40%-BFR, and 60%-BFR) that were applied in random order. IOP was measured before each condition, immediately after each repetition, and after 1 minute of passive recovery. A two-way repeated-measures ANOVA (restriction type [no-BFR, 40%-BFR, and 60%-BFR] x measurement point [basal, repetitions 1–10, and recovery]) was applied on the IOP measurements. Results: A significant main effect of the BFR condition (p = .022, ƞp2 = 0.21) was observed due to the significantly higher mean IOP values for the 60%-BFR (19.0 ± 0.7 mmHg) compared to the no-BFR (18.0 ± 0.8 mmHg; p = .048, dunb = 1.30). Non-significant differences with a large effect size were reached between 60%-BFR and 40%-BFR (18.1 ± 0.8 mmHg; p = .081, dunb = 1.16) and between no-BFR and 40%-BFR (p = .686, dunb = 0.18). IOP increased approximately 3–4 mmHg from baseline to the last repetition. Conclusions: Low-pressure BFR (40%-BFR) in combination with moderate-load (10RM load) resistance exercise could be an effective and safe strength training strategy while avoiding IOP peaks associated with heavy-load resistance exercises. These findings incorporate novel insights into the most effective exercise strategies in individuals who need to maintain stable IOP levels (e.g., glaucoma patients).

Evaluation of Practice Patterns for the Care of Open-angle Glaucoma Compared with Claims Data: The Glaucoma Adherence and Persistency Study

Evaluating Goldmann Applanation Tonometry Intraocular Pressure Measurement Agreement Between Ophthalmic Technicians and Physicians

SUMMARY Using an applanation tonometer, 5 replicate intraocular pressure (iop) measurements were obtained from each eye of 12 young, clinically normal, American alligators. Alligator length ranged from 46 to 117 cm, measured from snout to tail tip. All iop were recorded by a single observer at an ambient temperature of approximately 25 C, and ranged from 5 to 35 mm of Hg. Observer reliability was excellent (intraclass r = 0.93), and iop did not change over the ordered sequence of 5 replicate measurements/eye. Replicate iop measurements were, therefore, averaged in each eye for comparison between eyes of the same alligator. Left and right eye iop were highly correlated within individual alligators (r = 0.92), whereas the mean within-animal difference between left and right eye iop was not statistically significant (95% confidence interval [ci] for the left eye-right eye mean difference, −1.9 to 1.5 mm of Hg). Mean iop determined for 5 confirmed females and 3 confirmed males did not differ significantly between the sexes (95% ci for the male-female difference in means, −2.1 to 3.7 mm of Hg). Mean ± sem iop of 23.7 + 2.1 mm of Hg determined for 4 alligators &lt; 50 cm long was significantly (P = 0.009) greater than mean iop of 11.6 + 0.5 mm of Hg determined for 8 alligators &gt; 50 cm long (95% ci for the difference in means, 8.5 to 15.7 mm of Hg). In young alligators, the relation between body length and iop appears to be nonlinear, possibly with a negative exponent.

Background: Nonadherence to clopidogrel after drug-eluting stent (DES) placement is associated with in-stent thrombosis and adverse cardiac events. Objective: To identify the incidence of and barriers associated with nonadherence to clopidogrel in patients receiving DES. Methods: Patients who received a DES between March 1, 2004, and August 31, 2005, from a single academic medical center were eligible. Telephone interviews were conducted 6 or more months following discharge. Nonadherence was defined as premature discontinuation of or less than 80% adherence to clopidogrel. Patients were asked to identify barriers to adherence. Differences between adherent and nonadherent patients were analyzed using χ2 and t-test analysis. Results: Of the 674 patients identified, 257 (38%) participated. The nonadherence rate was 20%. The majority (58%) of nonadherent patients discontinued therapy prematurely. Patients identified the main reason for discontinuation as medical barriers (18.56%), including perceived adverse effects (9.28%). The Incidence of rash was higher in patients who were nonadherent (12% vs 4%; p = 0.049). Overall, 49% of patients recalled receiving discharge counseling regarding adverse effects. A financial barrier was identified by 22 (42%) patients in the nonadherent and 73 (36%) in the adherent group, of whom 64% and 52%, respectively, reported having insurance coverage for medications. Adherent patients reported higher copays ($29.69 vs $18.14; p = 0.01). Conclusions: Prospective studies should be conducted to aid in identifying patients at risk for nonadherence and possible in-stent thrombosis in order to identify interventions to improve adherence.

To identify the correlation between the difference of intraocular pressure measurements (IOP) obtained using the Goldmann applanation tonometer (GAT) and three others tonometers (Handheld applanation tonometer - HAT, Dynamic contour tonometer - DCT and Tono-Pen®) with biometric characteristics (corneal diameter, pachymetry, keratometry and axial length) in patients with congenital glaucoma. A cross-sectional study was performed on 46 eyes from 46 patients with congenital glaucoma. IOP measurements were obtained in all patients using GAT, HAT, DCT and Tono-Pen®. Keratometry, pachymetry, biometry and corneal diameter measurements were performed after the IOP measurement. The order of the tonometries was randomized. The correlations between the differences of IOP values of GAT and the other tonometers (Delta-IOP), and the different biometric parameters were studied. Tono-Pen® Delta IOP revealed moderate positive correlation to keratometry (r=0.41, p=0.004). The other Delta-IOPs showed no correlation with any of the biometric characteristics evaluated. IOP differences between GAT (gold standard) and GAT, HAT, DCT or Tono-Pen tonometers seem not to correlate with majority of ocular biometric characteristics. The only exception was the keratometry, which correlated in a positive and moderate way with Tono-Pen® Delta-IOP. This result suggests that the differences of IOP values of Tono-Pen® and GAT increase with the steepness of the cornea.

Background: Oncology nurses in Germany are routinely exposed to cytotoxic drugs that classified as carcinogenic, mutagenic and reprotoxic. Continuous or repeated contact, particularly in environments where containment systems and protective measures are inadequate or inconsistent, has been associated with incidence of adverse events, including malignancies, reproductive disorders, and genetic damage. Despite existing regulations in Germany and European directives, evidence suggests variability in protective practices and uneven implementation of guidelines. This study aimed to provide a comprehensive overview of training, protective measures, handling practices, and self-reported health outcomes among oncology nurses in Germany. Methods: A national cross-sectional survey was conducted by the European Biosafety Network in collaboration with the Konferenz Onkologischer Kranken- und Kinderpflege. The questionnaire captured demographics, awareness of guidelines, training frequency, availability of protective equipment, handling practices, occurrence of spills and leaks, reporting systems, and self-reported symptoms. Results: We received 1012 responses. The workforce was predominantly female (82.0%) and highly experienced, with 54.7% reporting over a decade of exposure to cytotoxic agents. While 60.7% indicated that refresher training was provided, one quarter reported receiving no such training. Familiarity with safety guidelines was inconsistent, with more than 40% unfamiliar or unsure. Access to basic PPE, such as gloves, was nearly universal (93.0%), but fewer than one-third (32.2%) reported access to closed-system transfer devices (CSTDs). Medical monitoring was absent in nearly two-thirds of institutions. Fluid leaks during administration were reported by 83.4% of respondents, with 10.6% describing them as occasional or frequent. A small but notable proportion (8.2%) reported symptoms associated with occupational exposure. Cross-tab analyses suggested cumulative exposure effects with a higher prevalence of symptoms among nurses with longer professional experience, and reduced leakage in settings using CSTDs. Conclusion: There are substantial gaps between regulatory standards and clinical practice in Germany. While variability in training, inconsistent access to advanced protective technologies, and limited surveillance measures leave oncology nurses vulnerable to unacceptable exposure levels. Greater standardisation, investment in closed-system technologies, and improved monitoring and reporting mechanisms are urgently needed to protect this workforce and align practice with international safety standards.

Sarcopenic obesity (SO), characterized by the coexistence of excess adiposity and diminished muscle mass and function, represents an increasing health concern among the older adults. Resistance and aerobic exercises are effective strategies for managing this condition. However, due to low exercise adherence among older adults, the current state of prevention and control of SO remains challenging. Moreover, qualitative insights into the specific exercise experiences of this population, particularly in the Chinese context, are lacking. This study seeks to elucidate the barriers and facilitators to exercise adherence among elderly individuals affected by SO through the application of the Theoretical Domains Framework (TDF) and the Capability, Opportunity, Motivation-Behavior (COM-B) model. This study employed a descriptive qualitative research methodology. From March to September 2024, 21 community-dwelling older adults with SO were recruited in Southwest China to participate in face-to-face, semi-structured interviews. Participants were aged 60 years or older and diagnosed with SO. The interview outline was developed based on the TDF, and interviews were audio-recorded and transcribed verbatim. Data were analyzed using both deductive and inductive approaches, and the identified themes were mapped onto the TDF and the COM-B model. This study analyzed a total of 488 utterances, which comprehensively covered 12 domains of the TDF and the 3 core components of the COM-B model. Six barrier themes and three facilitator themes were identified. The main barriers included inadequate capability (e.g., lack of knowledge, insufficient exercise confidence, poor self-control), limited opportunity (e.g., unsafe environments, body image pressure), and insufficient motivation (e.g., lack of security). The facilitators included motivation (e.g., perceived benefits of exercise, perceived disease threat) and opportunity (e.g., multidimensional social support). This study revealed that exercise adherence among geriatric individuals with SO is influenced by a complex interplay of factors. The key barriers identified were insufficient exercise confidence and lack of security. Future research should incorporate targeted behavioral intervention strategies, such as demonstration of the behavior, verbal persuasion about capability, pros and cons, and restructuring the physical environment, to effectively address the multifaceted challenges associated with SO in older adults. These strategies should be central to the development of effective intervention programs aimed at promoting physical activity among this cohort.

<sec> <title>BACKGROUND</title> Cervical cancer is a common cause of death among women globally, particularly in Africa. Each year, an average of 7093 women in Nigeria die from cervical cancer. Clinical practice guidelines developed by the Society of Obstetrics and Gynecology of Nigeria (SOGON) aim to prevent cervical cancer. However, the extent of their adoption among gynecologists remains unclear. </sec> <sec> <title>OBJECTIVE</title> This study aimed to assess Nigerian gynecologists’ awareness, understanding, and incorporation of the SOGON clinical practice guidelines for cervical cancer prevention in their clinical practices. </sec> <sec> <title>METHODS</title> A convergent parallel mixed methods design was used. Quantitative data were collected via a web-based and in-person survey distributed to gynecologists attending the 57th SOGON Annual General Meeting in Kano, Nigeria (November 2023). A total of 105 gynecologists completed the survey (response rate: 80%). Key informant interviews (n=12) were conducted to provide qualitative insights. Quantitative data were analyzed using descriptive and inferential statistics, including logistic regression (&lt;i&gt;P&lt;/i&gt;&lt;.05). Thematic analysis was applied to qualitative data. </sec> <sec> <title>RESULTS</title> Among the 105 respondents (mean age 50, SD 8.3 y and mean postresidency practice 12, SD 9.4 y), 98 (93.3%) reported awareness of the SOGON guidelines, and 74 (70.5%) endorsed their importance for cervical cancer prevention. However, only 58.1% (61/105) of the respondents reported integrating the guidelines into routine clinical practice. Barriers to implementation included limited training (71/105, 67.6%), resource constraints (64/105, 60.9%), and lack of institutional support (57/105, 54.3%). Qualitative data reinforced the need for more tailored guidelines for high-risk populations and rural settings. In addition, 70.5% (74/105) of the respondents advocated for a participatory guideline review process to ensure relevance and feasibility. </sec> <sec> <title>CONCLUSIONS</title> While awareness of the SOGON guidelines is high, their integration into clinical practice remains suboptimal due to systemic barriers. Strengthening training programs, improving access to resources, and enhancing institutional support are critical to increasing guideline adoption and advancing cervical cancer prevention efforts in Nigeria. </sec>